NCEPOD: Trauma - Who Cares? - London Health Programmes

2Organisational dataCHAPTER 2 - Organisational dataThis chapter summarises the collated data from the183 hospitals that returned a completed organisationalquestionnaire. It provides the reader with an overview of thedepartments, facilities, staff and protocols that were availablefor the care of severely injured patients during the studyperiod.Departments and proceduresTable 7 summarises the departments and/or proceduresthat were available at the participating hospitals. It shouldbe noted that some hospitals without a specifi c departmente.g. vascular surgery, did have staff that were able to performsurgical procedures related to that specialty.The most striking, albeit well known fact, was the smallnumber of hospitals that had a neurosurgery department(31) or performed neurosurgical procedures (a furtherseven hospitals). This is of particular concern given thelarge number of severely injured patients who sufferedneurotrauma as part of their constellation of injuries (over60% of patients in this study). The availability in patientservices is also refl ected in the Transfer chapter later in thisreport. By far the most common reason for a secondarytransfer was the requirement for neurosurgery and/orneurological monitoring. Time to defi nitive neurosurgicalintervention can be a major determinant of outcome forpatients with traumatic brain injury and the requirementfor a secondary transfer to access neurosurgical serviceslengthens this time (see Time to surgery page 106).More than half of the patients in the current study presentedto the emergency department out of hours. Furthermore,many required immediate treatment. While in the largemajority of hospitals procedures were available fororthopaedic trauma (168/173) and general surgery (166/173)out of hours, immediate intervention for more specialisedinjuries was often not available.Table 7. Overview of departments and proceduresDepartmenton siteDepartment not on site butspecialty procedures availableSubtotalNotansweredTotalYes Yes NoOrthopaedic trauma 166 7 9 182 1 183Neurosurgery 31 7 132 170 13 183General surgery 173 2 7 182 1 183Vascular surgery 131 15 33 179 4 183Plastic surgery 44 30 98 172 11 183Cardiac surgery 28 7 136 171 12 183Thoracic surgery 31 24 115 170 13 183Maxillofacial surgery 111 13 53 177 6 183ENT 137 14 28 179 4 183Urology 153 13 15 181 2 183Vascular interventional radiology 108 19 47 174 9 18325